Surgical procedures today generally require the use of multiple instruments like clamps, forceps, and retractors. Over the years, surgical procedures along with the type and quantity of instruments used in a given procedure have become substantially standardized. Many of the above-mentioned instruments are scissor type instruments, having a pair lever members that are connected through a pivot to working members. The lever members typically include ring handles at the ends thereof to facilitate the opening and closing of the instrument by a user's fingers.
Instruments used in surgical procedures are typically processed as follows. Dirty or used instruments received from the operating room are removed from a container in which the instruments have been carried and placed loosely in a sink typically filled with water and a cleaning solution. After the instruments have been soaked, they are removed by hand, individually cleaned with a brush, and rinsed. The instruments are then inspected, counted, and organized in the order of use. They are then placed on "stringers", which are oval shaped metal rods inserted through the handles of the instruments. The open ends of the stringers are closed with clamps to prevent instruments from being accidently removed. The strung instruments are then placed into one of a variety of commercially available sterilization baskets or containers. The container and instruments therein are sterilized with steam or ethylene oxide and then presented to operating room staff for their intended use.
The operating room circulating nurse will open the container for presentation of the instruments in a sterile field. The scrub nurse will remove the instruments, which are still attached to the stringers, from the container and place them on an instrument roll. (The instrument roll is typically made from a sterilized towel that the scrub nurse has formed into a roll.) The stringers are then removed and the instruments are counted. Once the surgical procedure is completed, the instruments are again counted. They are then placed in a basin or back in the container with any gross contamination removed and returned to the central supply.
Much time is wasted during the cleaning, organizing and counting procedure in the central supply. In addition, the onset of AIDS and other infectious diseases has dramatically increased the biohazard risk for central supply personnel. In response, OSHA has established the previously cited new standards for the handling of surgical instruments, particularly sharps.
The typical procedure for setting up the operating room, including removing the stringer, creating an instrument roll, and counting the instruments, is also time consuming. Counting the instruments before and after the surgical procedure is particularly important for ensuring that no instruments are left in the patient after the procedure has been completed. Designated operating room personnel have the responsibility to maintain a count of the instruments, and their mental alertness and memory must be relied upon to prevent mistakes. Also, post operative x-rays of patients, which have become generally routine, may give the operating room staff a false sense of security.
Clamps and other instruments are often lost with the patient draping. The instruments maybe difficult to recover especially if they are disposed in a "red bag" and incinerated. Hospital procedures restrict employees from opening these bags once closed and removed from the operating room.
A variety of devices exist for storing and handling surgical instruments. For example, U.S. Pat. No. 3,925,014 issued for Langdon discloses a wire rack type device for storing and supporting surgical instruments. This device employs special clamps to hold and group instruments and does not lend itself to easy use in an autoclave. The working members of the instruments are generally limited in the degree to which they can be opened, and the instruments may have to be removed to ensure complete cleaning. Also, no mechanism is provided for preventing the working members coming into contact with each other. Furthermore, the retaining bars of the device, which engage the instruments, may scratch or damage the instruments.
Other instrument racks are disclosed in U.S. Pat. Nos. 4,342,391 issued to Schainholz, 4,229,420 issued to Smith et. al., 4,577,755 issued to Ramsay, and 5,137,151 issued to Choate. These racks share many of the same problems as the Langdon device. For example, the working members of instruments stored in the Schainholz, Smith et. al. and Choate devices are not prevented from coming into contact with each other. Moreover, the devices disclosed in these patents include wound wire rings or boots, which make the cleaning process difficult and may necessitate the removal of the instruments from the rack for complete cleaning. Additionally, the Choate design does not provide adequate drainage to facilitate removal of gross contaminants. With the possible exception of the Smith, et. al. patent, the references disclose devices made of metal parts that engage the instruments, thereby increasing the likelihood of scratching or otherwise damaging the instruments, which are often delicate and expensive.